Carcinoma Esophagus | Medical Science Optional Notes for UPSC PDF Download

Common causes of cancers in INDIA

Etiology

• Squamous Cell Carcinoma:
  • Globally prevalent and the most common type.
  • Affects the upper two-thirds of the esophagus.
  • Associated with risk factors such as smoking and alcohol consumption.
• Adenocarcinoma:
  • Predominantly observed in Western populations.
  • Primarily involves the lower one-third of the esophagus.
  • Linked to factors like gastroesophageal reflux disease (GERD) and Barrett's esophagus.
  • Other contributing factors include obesity, nutritional deficiencies, and fungal contamination.

Clinical features

TNM staging scheme for esophageal cancer

• High-grade dysplasia signifies severe cellular abnormalities.
• T1: Tumor penetration into the lamina propria or submucosa.
• T2: Tumor infiltration into the muscularis propria.
• T3: Tumor infiltration beyond the muscularis propria.
• T4a: Tumor extension into nearby structures like pleura, pericardium, or diaphragm.
• T4b: Tumor invasion into adjacent structures like trachea, bone, or aorta.
• NO: No presence of lymph node metastases.
• N1: Lymph node metastases detected in 1-2 nodes.
• N2: Lymph node metastases detected in 3-6 nodes.
• N3: Lymph node metastases detected in 7 or more lymph nodes.
• M0: No distant metastases observed.
• M1: Presence of distant metastases excluding lymph nodes.
• Early stage (T1/T2, NO) typically treated with surgery alone.
• Advanced lesions (T3/T4, N1) often require a multimodal approach combining various treatments.
• Early stage (T1/T2, NO) usually addressed primarily through surgery.
• Advanced lesions (T3/T4, N1) usually demand a combination of treatments.

Investigations

• Upper Gl Endoscopy 
• Bronchoscopy
• Laparoscopy
• CT scan 
• Endoscopic Ultrasound (EUS)
• PET CT

General Principles

• Around two-thirds of patients have a form of the condition that cannot be cured and necessitates palliative care.
• Surgery is the primary method for a potential cure.

Radical treatment options:

• Radical esophagectomy coupled with Lymphadenectomy

Minimal treatment options:

• Endoscopic mucosal resection
• Photodynamic therapy

Management Algorithm

Curative treatment

Surgical

• One phase 
• Two phase (Lewis Tanner) 
• Three phase (Mckeown)

Complications

Early 

• Anastomotic leakage 
• Chylothorax
• RLN injury

Late 

• Gastroesophageal reflux 
• Stricture

Palliative treatment

• Insertion of a breathing tube for ventilation.
• Endoscopic procedures, including:
  • Laser treatment
  • Bipolar diathermy
  • Argon beam plasma coagulation
  • Injection of alcohol
• Brachytherapy, a form of radiation therapy.
• Chemotherapy utilizing platinum-based medications.

Previous Question

Q: List the most five commonly found cancers in India. Enumerate the clinical features of carcinoma of upper third of esophagus. How would you manage a case of carcinoma of upper third of esophagus? (2014)